周玉琴　　徐亞青　　鄭建娣　　陳芳芳　　王芳

[關(guān)鍵詞] AIDET溝通;六西格瑪管理;床邊快速血糖;疼痛

[中圖分類號] R473? ? ? ? ? [文獻(xiàn)標(biāo)識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）20-0170-05

Application of AIDET communication combined with 6 Sigma management in decreasing the pain in rapid detection of blood glucose at bedside

ZHOU Yuqin? ?XU Yaqing? ?ZHENG Jiandi? ?CHEN Fangfang? ?WANG Fang

Department of Endocrinology， Zhejiang Integrated Traditional and Western Medicine Hospital， Hangzhou? ?310003， China

[Abstract] Objective To observe the application effect of AIDET communication combined with 6 Sigma management in decreasing the pain in rapid detection of blood glucose at bedside. Methods A total of 94 diabetic patients admitted to the department of endocrinology of our hospital from January to June 2019 were selected. AIDET communication mode combined with 6 Sigma management method were used as an improvement tool. Before improvement， patients were included in the control group（n=48）， while after improvement， patients were included in the observation group（n=46）. The instant pain score， pain score after 24 hours， pain score of left hand and right hand， pain score of each finger between the two groups， and change of subjective data before and after improvement were compared. Results The NRS scores of patients in the observation group were lower than those in the control group instantly after rapid detection of blood glucose at bedside and after 24 hours， and the differences were statistically significant（P<0.05）. Compared with that of at beside， there were significant differences in the NRS scores between the left hand and right hand in both the two groups after 24 hours（P<0.05）， and the NRS score in the observation group after 24 hours was lower than that in the control group， with significant differences（P<0.05）. There were significant differences in the the proportion of knowledge， no idea of subjective information between the two groups （P<0.05）. Conclusion Using AIDET communication combined with 6 Sigma management mode to decrease the pain in rapid detection of blood glucose at bedside can effectively reduce the pain of patients， which embodies the concept of humanistic care in high-quality nursing.

[Key words] AIDET communication; 6 Sigma management; Rapid detection of blood glucose at bedside; Pain

血糖監(jiān)測是糖尿病管理的五架馬車之一，其監(jiān)測結(jié)果有助于評估糖尿病患者糖代謝紊亂的程度，便于醫(yī)生制訂合理的降糖方案，同時在治療過程中及時反映降糖治療的效果，為醫(yī)生及時調(diào)整治療方案提供依據(jù)[1]。醫(yī)院內(nèi)血糖監(jiān)測主要通過快速、簡便、準(zhǔn)確的床邊快速血糖檢測（Point of care testing，POCT）[2]實現(xiàn)，其中手指部血流豐富，毛細(xì)血管全血采取與靜脈血漿采血血糖值結(jié)果誤差不大，其結(jié)果能較準(zhǔn)確且快速反映血漿葡萄糖水平[3]，被認(rèn)為是最理想的末梢采血部位?；颊呷朐簳r一般會采取胰島素強化降糖治療，《國家基層糖尿病防治管理指南（2018）》[4]指出，如果糖化血紅蛋白未達(dá)標(biāo)，建議使用胰島素治療的患者每天監(jiān)測4～7次，而不使用胰島素治療的患者每周測3 d血糖，5～7次/d，建議涵蓋空腹、三餐前后、睡前，如遇特殊情況，可增加血糖監(jiān)測次數(shù)?；颊弑O(jiān)測血糖次數(shù)頻繁，指尖處末梢神經(jīng)分布密集，疼痛的敏感性較強，頻繁的指尖穿刺采血給患者帶來生理痛苦和心理負(fù)擔(dān)，導(dǎo)致患者對血糖監(jiān)測產(chǎn)生恐懼感，從而影響血糖監(jiān)測的依從性[5]。目前臨床上使用的血糖檢測方案有毛細(xì)血管血糖監(jiān)測、持續(xù)葡萄糖監(jiān)測、瞬感動態(tài)血糖監(jiān)測、糖化血紅蛋白、糖化白蛋白等[6-7]，但是從費用、準(zhǔn)確性等方面考慮，臨床上仍首選POCT，因此尋找有效的方案幫助住院糖尿病患者減輕床邊快速血糖疼痛感，尤為迫切。本研究運用AIDET（Acknowledge問候→Introduce自我介紹→Duration過程→Explanation解釋→Thank you感謝）溝通模式聯(lián)合六西格瑪管理方法對原血糖監(jiān)測流程進(jìn)行優(yōu)化，制訂了改良版的手指輪換法，并在臨床應(yīng)用，取得了較好的效果，現(xiàn)報道如下。